- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,302.69 / $22,908.68
| Facility | | $7,943.28 | $12,302.69 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $16,595.87
| Facility | | $6,760.83 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,128.31 / $16,595.87
| Facility | | $3,162.28 | $8,128.31 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,964.78 / $15,488.17
| Facility | | $6,025.60 | $10,964.78 | $15,488.17 |